ID

15630

Description

Routine documentation in German hospitals. Source file name: VL160106_Pflegekurve/ Pflegekurve.087 and Pflegekurve.088 Examplary forms provided by DMI (http://www.dmi.de/)

Link

http://www.dmi.de/

Keywords

Versions (3)
  1. 6/6/16 6/6/16 -
  2. 3/15/21 3/15/21 - Dr. rer. medic Philipp Neuhaus
  3. 9/20/21 9/20/21 -
Uploaded on

June 6, 2016

DOI

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License

Creative Commons BY-NC 3.0
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Nursing graph Routine documentation in German hospitals DMI

German

Nursing graph

1 forms  
  1. StudyEvent: ODM
    1. Nursing graph
Pflegekurve
Description

Pflegekurve

Patient
Description

Patient name

Data type

text

Alias
UMLS CUI [1]
C1299487
Geburtsdatum
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Patienten ID
Description

Patient ID

Data type

integer

Alias
UMLS CUI [1]
C1269815
Aufnahmedatum
Description

Admission date

Data type

date

Alias
UMLS CUI [1]
C1302393
Post- OP- Tage
Description

POST OP DAY

Data type

integer

Gewicht
Description

Weight

Data type

float

Alias
UMLS CUI [1]
C0005910
Kostform
Description

diet type

Data type

text

Alias
UMLS CUI [1]
C1550392
Temperatur
Description

Temperature

Data type

integer

Measurement units
  • °C
Alias
UMLS CUI [1]
C0039476
°C
ZVD
Description

Central venous pressure

Data type

text

Alias
UMLS CUI [1]
C0428640
Erbrechen
Description

Vomiting

Data type

text

Alias
UMLS CUI [1]
C0042963
Einfuhr gesamt
Description

Total Input

Data type

text

Alias
UMLS CUI [1]
C0429646
Ausfuhr gesamt
Description

Total output

Data type

text

Alias
UMLS CUI [1]
C3251815
Bilanz
Description

balance

Data type

text

Alias
UMLS CUI [1]
C0043064
Urin (DK/ Cystofix)
Description

Urine

Data type

text

Alias
UMLS CUI [1]
C0042036
Drainagen
Description

Drainage

Data type

text

Alias
UMLS CUI [1]
C0180499
Stuhl
Description

feces

Data type

text

Alias
UMLS CUI [1]
C0015733
Blutdruck
Description

Blood Pressure

Data type

integer

Alias
UMLS CUI [1]
C0005823
Blutdruckmessungszeit
Description

time Blood pressure measurement

Data type

time

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C3826646
BZ
Description

Blood glucose measurement

Data type

text

Alias
UMLS CUI [1]
C0392201
Blutzuckermessungszeit
Description

time Blood glucose measurement

Data type

text

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0392201
Verlaufsnotizen Arzt
Description

Physician note

Data type

text

Alias
UMLS CUI [1]
C3870373
Krankengymnastik (Durchführugn + Verlauf)
Description

physiotherapy

Data type

text

Alias
UMLS CUI [1]
C0949766
Enteral
Description

Enteral

Data type

text

Alias
UMLS CUI [1]
C1304890
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Parenteral
Description

Parenteral

Data type

text

Alias
UMLS CUI [1]
C0259961
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Antikoagulantien
Description

anticoagulants

Data type

text

Alias
UMLS CUI [1]
C0003280
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Insulin s.c
Description

Insulin subcutaneous

Data type

text

Alias
UMLS CUI [1]
C0586328
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Insulin i.v
Description

Insulin Intravenous

Data type

text

Alias
UMLS CUI [1,1]
C0021641
UMLS CUI [1,2]
C0348016
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Antibiotika/ -mykotika
Description

Antibiotics

Data type

text

Alias
UMLS CUI [1]
C0003232
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Infusionen
Description

infusion

Data type

text

Alias
UMLS CUI [1]
C0574032
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Plasma
Description

Plasma

Data type

text

Alias
UMLS CUI [1]
C0032105
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Blut
Description

Blood

Data type

text

Alias
UMLS CUI [1]
C0005767
Datum
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
Stop datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Arzt
Description

Physician

Data type

text

Alias
UMLS CUI [1]
C0031831
Prophylaxen-Therapie
Description

Prophylactic treatment

Data type

text

Alias
UMLS CUI [1]
C0199176
Datum Prophylaxen-Therapie
Description

Date Prophylactic treatment

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0199176
Anfang datum
Description

Begin date

Data type

date

Alias
UMLS CUI [1]
C1531783
Sr./ Pf./ A.
Description

Health Personnel

Data type

text

Alias
UMLS CUI [1]
C0018724
Stop Datum
Description

Stop date

Data type

date

Alias
UMLS CUI [1]
C1531784
Sr./ Pf./ A.
Description

Health Personnel

Data type

text

Alias
UMLS CUI [1]
C0018724
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Similar models

Nursing graph

1 forms
  1. StudyEvent: ODM
    1. Nursing graph
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Pflegekurve
Patient name
Item
Patient
text
C1299487 (UMLS CUI [1])
Date of birth
Item
Geburtsdatum
date
C0421451 (UMLS CUI [1])
Patient ID
Item
Patienten ID
integer
C1269815 (UMLS CUI [1])
Admission date
Item
Aufnahmedatum
date
C1302393 (UMLS CUI [1])
POST OP DAY
Item
Post- OP- Tage
integer
Weight
Item
Gewicht
float
C0005910 (UMLS CUI [1])
diet type
Item
Kostform
text
C1550392 (UMLS CUI [1])
Temperature
Item
Temperatur
integer
C0039476 (UMLS CUI [1])
Central venous pressure
Item
ZVD
text
C0428640 (UMLS CUI [1])
Vomiting
Item
Erbrechen
text
C0042963 (UMLS CUI [1])
Total Input
Item
Einfuhr gesamt
text
C0429646 (UMLS CUI [1])
Total output
Item
Ausfuhr gesamt
text
C3251815 (UMLS CUI [1])
balance
Item
Bilanz
text
C0043064 (UMLS CUI [1])
Urine
Item
Urin (DK/ Cystofix)
text
C0042036 (UMLS CUI [1])
Drainage
Item
Drainagen
text
C0180499 (UMLS CUI [1])
feces
Item
Stuhl
text
C0015733 (UMLS CUI [1])
Blood Pressure
Item
Blutdruck
integer
C0005823 (UMLS CUI [1])
time Blood pressure measurement
Item
Blutdruckmessungszeit
time
C0040223 (UMLS CUI [1,1])
C3826646 (UMLS CUI [1,2])
Blood glucose measurement
Item
BZ
text
C0392201 (UMLS CUI [1])
time Blood glucose measurement
Item
Blutzuckermessungszeit
text
C0040223 (UMLS CUI [1,1])
C0392201 (UMLS CUI [1,2])
Physician note
Item
Verlaufsnotizen Arzt
text
C3870373 (UMLS CUI [1])
physiotherapy
Item
Krankengymnastik (Durchführugn + Verlauf)
text
C0949766 (UMLS CUI [1])
Enteral
Item
Enteral
text
C1304890 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
Parenteral
Item
Parenteral
text
C0259961 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
text
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
anticoagulants
Item
Antikoagulantien
text
C0003280 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
Insulin subcutaneous
Item
Insulin s.c
text
C0586328 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
Insulin Intravenous
Item
Insulin i.v
text
C0021641 (UMLS CUI [1,1])
C0348016 (UMLS CUI [1,2])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
Antibiotics
Item
Antibiotika/ -mykotika
text
C0003232 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
infusion
Item
Infusionen
text
C0574032 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
Plasma
Item
Plasma
text
C0032105 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
Blood
Item
Blut
text
C0005767 (UMLS CUI [1])
Date
Item
Datum
date
C0011008 (UMLS CUI [1])
Stop date
Item
Stop datum
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Physician
Item
Arzt
text
C0031831 (UMLS CUI [1])
Prophylactic treatment
Item
Prophylaxen-Therapie
text
C0199176 (UMLS CUI [1])
Date Prophylactic treatment
Item
Datum Prophylaxen-Therapie
date
C0011008 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
Begin date
Item
Anfang datum
date
C1531783 (UMLS CUI [1])
Health Personnel
Item
Sr./ Pf./ A.
text
C0018724 (UMLS CUI [1])
Stop date
Item
Stop Datum
date
C1531784 (UMLS CUI [1])
Health Personnel
Item
Sr./ Pf./ A.
text
C0018724 (UMLS CUI [1])
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